"Us" and "Them" ... It Could Mean Trouble

The more I think about stories about patients... the more this thought comes to mind.

I finished my nursing education in Dec. 2004 and since that time I have noticed a major shift in the health care ideologies. I figure the best way to do something about it is to recognize it, discuss it and find solutions or underlying causes for it.

What I have noticed, is an "us" and "them" mentality, growing between healthcare professionals and the public. My background in ER nursing as a beside/ triage / charge nurse has given me ample opportunity to witness various accounts of this change. For instance, people have become WAAYY less tolerant, more demanding and seemingly harder to please.

I find that when people present to the emergency there is such a misunderstanding about what the department is for and how it works, that people are on edge the second they step in the door.

Don't get me wrong, long wait times, a CTAS triage scoring system that people may not understand and our system of expediting things that can be done in the waiting room probably does have a different perspective to those sitting in the waiting room feeling unwell. However, there must be something we can do to remind the patients that we the nurses do our best to make the department run efficiently and smoothly.

What they might not be familiar with is that the staff are balancing patient care with the medical wards and need for beds, the constant flow of ambulances into the department, the short staffed areas, the lack of CCU/ ICU or other specialized beds and it goes on and on.

Given all the variable factors, I feel that we in our department really do try to make the system work the best it can. I feel that if the "us" vs. "them" mentality continues we are in for an even more chaotic system.

From my point of view we should try and give the best quality care possible, keep the lines of communication open between everyone and never try to annoy someone "just because".

I also think not taking the situation personal helps and really listening to people also goes a long way. I know these things take time and can be stressful... BUT...

it is us nurses that understand the full depth of what is happening to our health care...

it is us that has the power to change and to educate the public about how things are.

We are the advocates of the public and it is our responsibility to prevent further deterioration of the relationship we call the nurse patient bond. We the nurses and the public as patients really need to work together and formulate a team that is not a force to be reckoned with I think that destroying this relationship can be detrimental to both nurses and patients.

The health care system in any sense doesn't exist without patients or nurses... therefore it is essential that we work together and overcome any unplanned hurdles of the health system.

Trouble is here. I noticed trouble when I, a silver hair nurse, was seated in a wheelchair in an ER lobby filled with running, laughing, playing children, young people chatting on cell phones, and no one appeared to be visibly ill or quietly sitting and waiting. The lights were bright, the large screen TV in the main corner was on loud and fast, and the receptionists were busy laughing and chatting with each other.

I was the last to be called and only after the shift change. The entire two hours I sat in the waiting room in my wheelchair, I vomited and retched repeatedly, filling the bucket on my lap with green slime and Kleenex. I had vomit down the front of my shirt and probably reeked of the acrid smell of vomit. I had been vomiting all day at home and my husband brought me here only after calling the ER first and was told to bring me in immediately. He was now sitting helplessly by my side in the waiting room, trying to get help for me from the numerous nurses and staff parading through the lobby. If not to be placing in an ER exam area, then at least a dark and quiet room to vomit in private. But all blatantly ignored us.

My husband finally demanded either a private space for us or we would leave. Perhaps it was a different crew or the sounds of my now dry retching was interrupting the incessant chatter, but the fresh receptionist jumped up and brought us to a wonderfully dim and quiet private room to wait. Five minutes later, the nurse came to bring me into the ER for examination and treatment by the doctor.

The point of this is that it only took less than a minute to connect with someone who then acknowledged our basic need for privacy and dignity, if not medical attention sooner than later. The response was to locate us to a quiet and private space while we waited. People will always be people. But I cannot find any reasonable excuse for the behaviors of the nurses who ignored my husband and I for nearly two hours in the waiting room. Infection control issues aside, it would have taken any one of them less than one minute to just acknowledge us and recognize we should have at least been in a quieter, more private location than the center of the busy lobby. Had that happened, my husband would not have had to demand and assert our need for privacy.

As a patient, I don't have to understand the staff's logistical needs or the process of triage. There is no acceptable reason or rationale - other than a major community disaster - for totally ignoring me as a patient for two hours in any condition. Absolutely none.

I believe that if you forget to connect and communicate with people and respect their humanity, you are less of a nurse and more of a corporate drone. It is then not health care but about a medical product. You are about meeting and improving the bottom line, not about connecting with people and facilitating healing. And it takes less than a minute of your valuable time. It also takes less than a minute for a health care professional to become one of "them", the "public", just another patient. But hey, if that happens - try not to take it "personal" and remember that the health care professionals are all trying their best to help you in these times of chaos.

FYI: Just sharing my thoughts and a true experience, not attempting to light a flame.

I think what is important about your post is the evident wide gap between patient and health care staff perspectives. I was trying to convey the tension nurses feel when they know people are waiting a long time and some underlying reasons for this. I assure you from my experience... we don't like people waiting that long... nor do we do it intentionally. The moral dilemma of making unwell people wait long hours with very challenging restraints is not something I has a nurse take lightly. I appreceiate hearing the patient view of what they see happening. I think that inorder to close the gap on the issue I am trying to bring up..more discussion and explanation needs to be done. I do think your siutation was unfortunate and didn't mean to mock similar scenarios. Sometimes coping mechanisms of staff are often portrayed negatively to others. I appreciate your willingness to share your story.

I also do think that the triage process is important for patients to be somewhat aware of.... sicker people do get in faster... certain things are emergent... and when I have a young adult patient with nausea/ vomitting screaming at me why I would take an older with stroke symptoms in before her... I think it is obvious that some of the public aren't familiar with the purpose of an ER.

As a nurse, I understand the processes of triage. I remember well the criteria that determines who gets in first and who can wait. I also understand the purpose of an ER. As a nurse, I understand the tensions inherent in doing my job well and knowing people are waiting for me. But the point of using my recent experience as an example of a nurse being on the other side of the health care experience is to point out that patients are not concerned with understanding all of your nursing processes that decide when they receive care. As a patient, that did not matter to me at all, other than my mind understood as the nurse brain in my head tends to function unless I am unconscious. As a patient, all one nurse would have had to do was to stop and take one minute to make a difference. I know that if I had been the nurse witnessing the vomiting patient in the busy ER, I would have taken a moment to direct other staff to relocate the patient to a quieter, private area - even if it were down a nearby hallway. I would have also communicated to the patient and her husband that they weren't being ignored and that until they brought back to be seen by the doctor, the staff in the waiting area were available to at least bring them Kleenex, water, or to the bathroom. That's all. No more. No less.

The public is more more aware of how things really are than you seem to know. Attempting to educate them while continuing to perpetrate and support the existing healthcare system will not serve to improve their understanding. The current healthcare system doesn't exist to serve people as patients and heal, but the majority of healthcare systems in the US are working in collusion with the insurance industry to keep up the illusion of "healthcare". But perhaps I digress a bit off point... or not. It is only because I have seen the true healing of body and/or of soul as I practice the art and science of nursing. What happens in many hospitals and medical centers today is not healing but economics. I am concerned when a nurse believes that if only the patient understood the complicated processes convoluting the system s/he has gone to for help, that the nurse would be helping relieve the stressors... sorry, but no. I think that if the nurse participates fully in such a system and believes it is right and good that to form a team with nurses and patients working together to bring change, than that nurse will soon be out of a job. This is a system that burns out healthcare workers and treats everyone like a number. If a nurse cannot take a minute to stop and use her powers to make an ugly situation better, where will she find the time to work with non-nursing people to organize as a collective and change a system that is bigger than you seem to understand? Think about it?

I also work in an ED. But I work in a military ED. What is so frustrating to me is the fact that the military offers free clinics for soldiers and their families, but they still continue to bring in the child with a low grade temp, the runny nose, the cough and congestion, the ear aches...things that could and should easily be seen at the clinics. This is one of the major delays in the care of the truely sick here. We take up the last bed in the ED with a child that has a cough, and then here comes the possible MI or possible pending CVA...so we shove someone out of a bed to get these to beds. And here is another point....when I was younger you didn't come to an ED if you were miscarrying...you did it in the privacy of your home and grieved with your husband. And this is in women who are like 6 or 7 weeks pregnant. I just do not understand.

And , by the way, I am one of those nurses who place migraine headache patients in a nice quiet,dark room to wait. And the pts who are actively vomiting also get placed out of the main ED. Just FYI

as someone who get migraines and once in a while must suffer the horrid ER, thank you. The retarded residents who want to stuff me full of narcs rather then treat the migraine are bad enough to deal with, but when you have to do that in a curtian room surrounded by loud people and bright lights it is enough to make you want to find a gun and go postal!

Patients need education on how to best use the ED. What a wonderful country we have that doesn't turn the sick and dying away from ED's when they're sick. All ED nurses should be proud of the care they provide to the sick across the US.

But many patient's don't understand when to use the ED, when to use clinics and when can treat their symptoms at home. We need to education patients ......and better partner with them in the ED when they arrive.

Perhaps we should create a web site that educates patients on when they should seek care through an ED and what they should do before arriving at the ED to make it easier for the staff to care for them. Wouldn't a simple check sheet about their symptoms that they print off and bring with them help expedite the process? The nurse and doctor could confirm information with the patient rather than starting with only what's in the hospital's computer system......

ED staff never know who is coming and what their problem is. Patients just show up....but many have cell phones or computers with text messaging.....why couldn't they let us know they are coming and do a self assessment before they arrive.....all in the interest of providing better care and making the ED function better. So when they arrived, the information about chief complaint, symptoms, etc. would be there for the nurse and doctor to confirm rather than starting with no information.

ED Nurses are great........and patients need to see them as their partners ....we're all trying to make the patient better..........:heartbeat